spinal cord injuryImages (Click to view larger image)
paraparesis, paraplegia, quadriparesis, quadriplegia, tetraplegia
Spinal cord trauma is an injury to the spinal cord. The spinal cord is the part of the nervous system that runs down from the brain through a canal in the spine. It sends signals between the nerves in the body, called the peripheral nerves, and the brain. Signals from sensations like pain or position are sent up the peripheral nerves from organs like skin and muscle. Commands to move the body are known as motor impulses. These impulses begin in the brain and travel down the spinal cord. They then travel through the peripheral nerves into tissues such as muscle to produce movement. When signals travel to or from the brain, they cross over to the other side. The left side of the brain receives sensation from, and sends motor signals to, the right side of the body and vice versa.
What are the signs and symptoms of the injury?
The main symptom of spinal cord trauma is a loss of movement and feeling below the level of injury. Trauma to the spine at or below the spot where the neck and chest meet will affect the legs. Complete loss of function at this level is called paraplegia. Incomplete loss is called paraparesis. Injuries involving the neck will also affect the arms. Complete loss of function in the arms and below is called quadriplegia. Partial loss in all four limbs is called quadriparesis. Below the level of injury, the person will lose:
These losses may be partial or complete. They may be temporary or permanent. It depends on the severity of the injury.
- position sense, or awareness of where the body is
- bowel, bladder, and sexual function
What are the causes and risks of the injury?
The spinal cord is like an electrical cable. It carries signals between the brain and the body. The spinal cord is protected by the bones of the spine, called vertebrae. Vertebrae are stacked on top of each other. A tunnel goes through the bones. The spinal cord and nerves go from the brain to the tailbone in this tunnel. Nerves branch off from the spinal cord between each of the bones of the spine. Spinal cord trauma occurs when that protection is damaged.
Trauma can be caused by:
In 1996 - 97, 264 people sustained SCI from traumatic causes. The highest count and age specific rate occurred in the 15 - 24 years age group. 80% of all injured were male and 20% were female. The causes of these injuries are:
- fractures to the bones
- injuries that cause the bones to move out of alignment
- severe stretching of the spine
- penetrating injuries such as stabbing or gunshot
Sports produce a special set of risk statistics. Two-thirds of spinal injuries during sports are diving accidents. Ninety-two percent of sports injuries result in quadriplegia. Alcohol in the bloodstream worsens spinal cord injuries. This is because bleeding can cause the alcohol to come into contact with spinal cord tissue.
- motor vehicle accidents (27%) Highest
- acts of violence
- other reasons
What can be done to prevent the injury?
A number of actions can help prevent spinal cord injury. They include:
How is the injury diagnosed?
- using seat belts
- not driving after drinking alcohol
- using proper sports equipment
- using proper sports techniques, like keeping the head up while tackling in football
- jumping, rather than diving, into water
- avoiding medications that lower blood clotting ability, such as aspirin, which make injuries more severe
Spinal cord trauma is first diagnosed when a person has a loss of function below the level of the injury. Because this is so serious, all injured people must be assumed to have a fractured spine and cord injury until a physical examination and X-rays rule it out. Various imaging studies, such as MRI or CT scans and myelograms may be used.
What are the treatments for the injury?
Treatment of spinal cord trauma is tailored to the injury, because each case is unique. Steroids, such as methylprednisolone, can reduce swelling, but their use is controversial. If the spine is fractured, spinal fusion, or joining the bones of the spine with surgery, may be needed. This can stabilise the injury and shorten the recovery. Rehabilitation often takes a long time. The goal is to achieve the most function and independence possible. Some experimental drugs are being studied. These drugs are designed to reduce scarring at the injury site. They may improve re-growth of nerves.
What are the side effects of the treatments?
Without proper treatment, many complications can occur:
With treatment, people can re-learn ways to control their body and how to do activities. It is possible to go back to normal activities, such as school, work, marriage, and having children. Usually, the person will use a wheelchair. There are special tools that help with tasks such as feeding and getting dressed, even with limited hand movement. There are therapists who specialise in treating people with nerve damage. Doctors who specialise in rehabilitation, urology, orthopaedics, neurology, and other specialties are needed to provide complete treatment.
- People with spinal cord injury are at high risk for bedsores. This is because they lack sensation and movement below the injury level.
- Kidney infections and kidney stones may result from a loss of bladder control.
- Respiratory problems, such as pneumonia, are sometimes seen when the injuries involve the neck.
- People with quadriplegia may have trouble controlling body temperature, blood pressure, and heart rate.
What happens after treatment for the injury?
The financial and emotional costs to society of spinal trauma are great. Medical costs during the first year after leaving the hospital can be more than $50,000 per person. These costs decrease only slightly after the first year. Because of complications, only 85 percent of people with cord injury are alive 10 years after injury. This compares to 98 percent of uninjured people of similar age and sex. Only 35 percent of paraplegics and 25 percent of quadriplegics are employed 8 years after the injury. Marriage rates are lower. Divorce rates are higher. People with cord injuries can feel isolated. They may need psychological counselling. Many laws have been created to give more help to people with disabilities. These laws will continue to make it easier to work and be a productive member of society. It is important that society continues learning to accept people who have a disability so that they can do more.
Author: James Warson, MD
Reviewer: eknowhow Medical Review Panel
Editor: Dr John Hearne
Last Updated: 17/10/2004
Potential conflict of interest information for reviewers available on request